Interpretation of Shenzhen Social Security Policy

→ Dongguan → Dongguan Medical Insurance

Interpretation of Shenzhen Social Security Policy in 2022-2023

2022-09- 16 14:59:58

(

Note: Please refer to the previous materials for the content arrangement in 2022!

)

It was learned from the Municipal Social Security Bureau that with the adjustment of the average wages of employees in Guangdong and Zhuhai, the payment base of endowment insurance, basic medical insurance and maternity insurance in our city has increased to 18 162 yuan; The first payment base of basic medical insurance was adjusted to 3632 yuan; Funeral allowance for workers who died at work was raised to 36,324 yuan.

1. After the insured goes through the insurance formalities and pays the medical insurance premium, he/she will enjoy the medical insurance benefits stipulated in these Measures from the next month 1 day. Insured before the 20th of each month shall be deemed as insured in that month; After the 20th day of each month, the applicant will be insured on a monthly basis.

Shenzhen social security payment base and standard

2. If the insured unit and the insured person stop paying medical insurance premiums, they will stop enjoying the medical insurance benefits paid by the medical insurance pooling fund from the next month 1 day after the interruption of payment, but the balance of their personal accounts can continue to be used.

3 for the city's registered infants to apply for insurance procedures, starting from the month of application, and enjoy medical insurance benefits from the next month of payment; Within 30 days from the date of entering the household, those who apply for insurance with a copy of the baby's birth certificate and the mother's ID card can pay the fee from the month of birth and enjoy medical insurance benefits according to the relevant provisions of these measures from the date of birth.

First, the scope of reimbursement of basic medical insurance in Shenzhen

1. The personal account of the insured in the first stage of basic medical insurance is used to pay for basic outpatient medical expenses, local supplementary medical expenses, and the expenses of purchasing drugs within the scope of medical insurance catalogue at designated retail pharmacies with prescriptions issued by doctors in designated medical institutions in Shenzhen. The part that is not paid in the personal account shall be paid by the individual. Social security designated medical institutions in various districts of Shenzhen

Two, Shenzhen social security designated retail pharmacies

2. If the first-class insured person of basic medical insurance has been insured for one year in a row, the outpatient basic medical expenses and local supplementary medical expenses paid by individuals in the same medical insurance year exceed 5% of the average salary of employees in Shenzhen last year (current standard: 49 18 yuan/month), and the excess part is paid by the basic medical insurance serious illness pooling fund or local supplementary medical insurance fund according to regulations, and the insured person over 70 years old pays 80%.

Note: The insured who enjoys the benefits specified in the preceding paragraph does not enjoy the following benefits:

70% of the basic medical expenses and local supplementary medical expenses incurred by the first-class insured in Shenzhen designated social rehabilitation center are paid by personal accounts, and 30% are paid by the basic medical insurance serious illness pooling fund and local supplementary medical insurance fund according to regulations.

Except for the following items:

1 oral treatment expenses;

2. Rehabilitation physiotherapy expenses;

3 large medical equipment inspection and treatment costs;

4 other items stipulated by the municipal government expenditure.

3. If the accumulated savings in personal accounts of Class I insured persons in basic medical insurance exceeds 5% of the average salary of employees in Shenzhen last year (current standard: 49 18 yuan/month), the excess can be used to pay the following expenses:

1 the cost of purchasing non-prescription drugs within the scope of basic medical insurance and local supplementary medical insurance drugs in designated retail pharmacies;

2. The basic medical expenses and local supplementary medical expenses paid by myself, my spouse and the immediate family members who have participated in the basic medical insurance in this Municipality at the designated medical institutions;

3 I and my spouse, immediate family members to participate in the city's basic medical insurance health examination and vaccination costs;

Other medical expenses stipulated by the state, Guangdong Province and this Municipality.

Third, how to calculate the social security base?

Shenzhen social security payment base will be adjusted with salary from July 1.

It was learned from the Municipal Social Security Bureau that with the adjustment of the average wages of employees in Guangdong and Zhuhai, the payment base of endowment insurance, basic medical insurance and maternity insurance in our city has increased to 18 162 yuan; The first payment base of basic medical insurance was adjusted to 3632 yuan; Funeral allowance for workers who died at work was raised to 36,324 yuan.

1, the pension insurance payment base is "offline" 2030 yuan.

The Municipal Social Security Bureau recently issued the Notice on Adjusting the Payment and Compensation Base of Social Insurance in Shenzhen: According to the statistics of this province and city, the average monthly salary of employees in Guangdong Province is 4,986 yuan, and that in Shenzhen is 6,054 yuan. Accordingly, from June 1 day to June 30, the average monthly salary of employees in this province and city in the previous year was calculated according to the standards of 4986 yuan/month and 6054 yuan/month.

After the adjustment, the pension insurance payment base has been "online". According to the regulations, if the total salary exceeds 300% of the average monthly salary of employees in this city in the previous year, the excess will not be included in the payment base. According to the average monthly salary of 6054 yuan, the "online" payment base of endowment insurance is 18 162 yuan. The "off-line" of the endowment insurance payment base is the minimum wage standard announced by the municipal government, which is 2030 yuan.

2, medical insurance "offline" 3632 yuan.

In terms of medical insurance, both the "online" and "offline" payment bases of the first file of basic medical insurance have improved. According to the regulations, if my total monthly salary exceeds 300% of the average monthly salary of employees in this city last year, I will pay 300% of the average monthly salary of employees in this city last year; If the total monthly salary is lower than 60% of the average monthly salary of employees in this Municipality last year, it shall be paid according to 60% of the average monthly salary of employees in this Municipality last year. According to the average monthly salary of employees of 6,054 yuan, the first payment bases of "online" and "offline" basic medical insurance are 18 162 yuan and 3,632 yuan respectively. The second and third grades of basic medical insurance were paid monthly at 0.7% and 0.5% of the average monthly salary of employees in this city in the previous year, and the payment base was all adjusted to 6054 yuan, 42.4 yuan for the second grade and 30.3 yuan for the third grade.

In terms of maternity insurance, the payment base of the employer's monthly maternity insurance premium is the sum of the payment bases of the employees of the unit. The employee's payment base is his total salary last month; The first-month payment base of employees who are newly employed, re-employed and newly established employers is their total wages in the first month. If the total salary exceeds 300% of the average monthly salary of employees in this city last year, the excess part will not be included in the payment base, which is the "online" of the payment base. According to the average monthly salary of employees, it is 18 162 yuan; The payment base shall not be lower than the minimum wage standard announced by the municipal government, which is the "offline" of the payment base, which is 2030 yuan.

3. Funeral allowance for work-related death is 36,324 yuan.

The payment of unemployment insurance has not changed. According to the regulations, the payment standard of unemployment insurance premium is: the employer pays 2% of the monthly minimum wage in this city according to the number of employees who should participate in unemployment insurance; Employees shall pay 1% of the monthly minimum wage in this city every month.

The amount of work-related injury insurance premium paid by the employer is the product of the total wages of employees multiplied by the unit payment rate. In terms of compensation for work-related injuries, the funeral subsidy is the average monthly salary of employees in the overall planning area for six months, which is adjusted to 36,324 yuan.

Four, basically realize the national social security card.

Statistics show that by the end of the year, the number of social security card holders in China reached 972 million. In many places, people can use a social security card to meet various needs, such as registration for medical treatment and financial payment. Social security cards will also basically realize the national one-card system.

According to Ministry of Human Resources and Social Security's information, Ministry of Human Resources and Social Security will speed up the establishment of a networked settlement system for medical treatment in different places, so as to ensure the basic realization of direct settlement of hospitalization expenses in different places that meet the referral conditions. Deepen the reform of the registration system of "five certificates in one" and improve the standardization system of social security handling services; Innovating management methods and service methods, speeding up the construction of electronic social security, and improving the standardization, informationization and specialization of social security management; Fully implement the national enrollment plan, basically build the national enrollment database, truly realize the "one card" and provide more convenient services for the people.